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Indeed. Water and fire cannot be discussed in the same breath; what theory can be used to connect them? I say: Humans exist within the intersection of heaven and earth's qi. In health, there is only one Taiji (Supreme Ultimate), containing the profound mysteries of Yin-Yang and the Five Elements, whose beginnings are invisible. When disease occurs, imbalance arises, and Yin-Yang and the Five Elements rub against and agitate each other, like wind stirring still water, naturally creating waves. If cold pathogen invades, manifestations of cold appear; this is the internal agitation of the disease mechanism within the waves, presenting phenomena of overturning, shifting, and recurring—this is "one dividing into two." Therefore, when humans are injured by cold, it transforms into a heat disease; excessive heat causes Fire Pathogen to manifest. For every unit of cold received, a unit of Fire manifests inversely; receiving ten units of cold results in ten units of Fire, which is due to momentum and principle. Hematemesis (vomiting blood) certainly appears as a sign of Fire, but the reason for this is actually that Cold Qi suppresses and urges it, giving Fire its power. The root of the disease lies not in Fire, but in Cold, which is clear! How can one merely attribute it to Fire because the appearance resembles Fire? Treating disease requires seeking the root and examining internally; one must not let superficial resemblance harm the true meaning.

Guest asks: Shanghan (Cold Damage) should be differentiated into six meridians; which meridian does your hematemesis belong to? I say: Cold is the command of winter. Humans become ill because this first disturbs Qi transformation. My disease resides in Qi transformation, so discussing it does not fit into specific meridians. Once entering a meridian, there is a fixed location, allowing for marked treatment methods and indications; that belongs to the Shanghan school and should be discussed separately. In early winter, I was extremely angry, which naturally triggered bleeding. Although I did not vomit it out, how could the blood remain clear? Moreover, Cold damaged the Ying (Nutritive) Blood, and the medication biased towards tonifying the Kidney. This terrifying situation was forced by circumstances.

Guest asks: If it is considered Cold pathogen, why not use dispersing methods, but instead bitter-cold purgatives, which seems to treat Fire? What is the meaning of using Adzuki Bean (Vigna angularis) and Forsythia Fruit (Forsythiae Fructus)? Why did drinking Lotus Seed Decoction induce sweating? I say: Harm caused by Cold must be distinguished by Yin/Yang and Exterior/Interior. I contracted Cold at night, turbidifying my blood, so the pathogen gathered in the Yin aspect. Yin belongs to tangible Ying Blood, located deeply; it is not an Exterior disease suitable for dispersing. Cold coagulation leads to Fire stagnation; logically, it must flare upwards. Without bitter-cold flavors to descend according to Fire's nature, the heat cannot be subdued. Fire-Heat stagnates and erupts; although the momentum is blazing, it originally arises from suppression and restraint, and must be treated as a deficiency pattern. Zhang Zhongjing said: "For Heart Qi deficiency causing hematemesis or epistaxis, Xie Xin Tang (Drain the Epigastrium Decoction) governs." To 'drain the heart' means to drain excess pathogens in the Blood level to balance the deficient Qi. With Heart Qi deficiency, Blood has no master; combined with accumulated stasis, severe stagnation causes violent burning, carrying blood upward, leading to panic and delirium. Without purging the tangible pathogen, how can efficacy be achieved? Although bitter-cold purgation seems to lower Fire, the trouble with Fire lies precisely in its inability to ascend properly. If tangible stasis is removed, Heart Qi flows freely without worry. The origin of Heart Qi deficiency truly lies in the solid, condensed, closed, and dense Cold. Once Fire is unblocked, who cares about the solid Cold? Thus, treating Fire is actually dispersing Cold. Using Forsythia exploits its easy dispersion; borrowing the color of Adzuki Bean (red enters the Heart), both aim to open Heart Qi, eliminating the harm of condensation. As for Lotus Seed, it obtains the essence of summer Qi, and the seed contains Jia Wood Qi, used to penetrate the beginnings of Heart Qi. Since Heart Qi is stagnant in the Yin, penetration returns through the Yin. Sweat is the fluid of the Heart; emerging from the Yin meridians of the hands and feet, the use of Lotus Seed acts like divine assistance (the principles expounded here are profoundly penetrating).

Guest asks: One dose of Sishen Wan stopped diarrhea and pain; after several doses of Liuwei Dihuang Wan, wheezing and urgency subsided. Efficacy is seen; why call this 'aiding growth' [of pathogen]? I say: My illness began with extreme anger, formed through contracting Cold, and erupted due to sexual excess. Comparing the Three Causes (Internal, External, Non-internal/External), the first two account for more than two parts, while the last accounts for less than one part. Now, using Sishen Wan to consolidate Kidney Qi and Liuwei Dihuang Wan to fill Kidney Essence, the Kidney becomes peaceful. However, Cold and Water combine their virtue, with severe freezing deep inside, suppressing the blazing Fire; this has its cause. Furthermore, the power of herbs and the shift of Qi and Blood occur within mere hairsbreadth; can one experiment lightly? The talk of 'aiding growth' is merely fear from those who understand the method.

Guest asks: Upon waking, Fire surges upward; where does the source come from? It overflows from the Stomach. Although there is cough and wheezing, it is unrelated to the Lung. If it came from the throat, it would be a True Zang syndrome, indicating no chance of survival. I say: Although the Stomach Meridian has abundant Qi and Blood, and the vomiting was intense, how much could it really be? Essentially, this blood exits the Stomach but does not originate from it. It is because violent anger injured the Liver, disturbing the mechanism of Blood storage. Moreover, during winter, closure and storage were not tight enough, allowing Cold to infiltrate. Ying Blood was greatly frustrated, and all blood in the body became turbid rather than coagulated. When lying down, blood returns to peace, and the Liver stores it. Now that it is turbid, it gathers and flows into the Sea of Stomach. Upon waking, Sheng Qi (Ascending Qi) rises, riding this wave to overflow.

Guest says: Hearing that ginger induces vomiting—is this also ascending Sheng Qi? I say: Blood flows in the Stomach, slowed by medicinal force. Ginger's pungent and fierce aroma touches the impending upward momentum, causing it to surge again. Nothing strange about this.

Guest asks: Before hematemesis, why was there initial unconsciousness? I say: This is a sign of accumulated Blood Stasis. Blood accumulating above causes forgetfulness; below, it causes mania and confusion. This is another name for forgetfulness, a manifestation of restlessness and mania. The Heart governs Blood and Spirit. Without Blood governance, movement becomes erratic; without Spirit governance, mania and forgetfulness follow.

Guest asks: Does Heart Qi deficiency match the pulse? I say: Since falling ill, the pulse has been wiry and weak, with the left Cun position particularly obstructed. This is a sign of righteous Qi deficiency; the wiry quality indicates Liver alteration and external binding by Cold.

Guest asks: The cause of hematemesis being Cold has three aspects; conversely, can Wind, Summerheat, Dryness, and Dampness be inferred similarly? I say: Within heaven and earth, within the six directions, there is only one Qi. Due to seasonal changes, there are distinctions among the six, but essentially five Qi, called similar categories. If it can be due to Cold, naturally the other four Qi can be inferred similarly. However, this can be pushed deeper. Hematemesis is one symptom; thus, any condition named by symptoms should be penetrated by the Five Qi. This is the crux of ten thousand diseases.

Guest asks: When the disease is urgent and the pulse is scattered, on what basis should medication be chosen? I say: One must rely on the syndrome, not necessarily the pulse. At this moment, life and death hang in the balance, like two armies facing each other, non-this-that. I, as the commander, need courage and strength to hold the line. Recalling once treating a son of a family friend, who vomited blood in the evening, felt vexed and dizzy, surrounded by panicked relatives. I had them support him with one hand and administer medicine with the other. After a long time, he went from vexation to dizziness. I suppressed my own fear and endurance, persisting without losing focus, waiting for him to stabilize before providing further care, thus turning danger into safety. This shows that the presiding physician must have great strength, risking oneself to advance, so the patient has reliance. If one cannot suppress fear or endure hardship, caring only for oneself and ignoring human life, life and death divide in a breath; how can this be ignored? Suppressing fear and enduring, persisting without loss, is the utmost words for saving critical conditions. Ancient physicians treated diseases with resolve, risking themselves to advance, thereby turning danger into safety. Modern physicians, despite fame, often abandon patients at slight signs of danger, fearing consequences, protecting their reputation, unwilling to bear any responsibility. Such people are too cruel; how are they different from bandits?

Note: Mr. Lu Bu Yuan's various writings often propose new meanings. This compilation is copied from a secret manuscript; fearing it may be lost, it is specially appended here.